The real war on vaccines

I should state my biases here. Firstly, I’m a physician who specializes in prevention medicine. My life’s work and passion is working with patients to prevent diseases before they happen.

Secondly, having been born in the early 1970’s and having travelled to Africa and South America, I am indeed fully vaccinated.

When I travel to a malaria endemic area- I take antimalarial medication. When exposed to a patient with active Tuberculosis, I start suppression therapy. If I have a needlestick injury at work in a high risk situation I will start HIV prophylaxis.

I always wear a seatbelt regardless of who is driving and my bike helmet is my best friend.

It is safe to say that when it comes to injury and disease, I like to leave very little to chance. As a scientist, I like to have as much science on my side as possible.

When I was a kid, vaccinations were not up for debate. Times were different. My parents were the polio generation. They had all-too-vivid memories of a school friend or neighbour who wound up contracting the illness. My parents came of age when Jonas Salk revolutionized the way we look at diseases.

Infections were no longer messes to clean up after. No longer did we hope and pray…. we vaccinated.

This was the dawn of a new age. Diseases could be prevented. And vaccines were just the beginning. A shift in medical thinking trickled down into our cultural psyche as well.

Seatbelts were scientifically proven to prevent traffic fatalities. Seatbelts became the law. Second hand smoke was shown to cause cancer in those exposed and smokers were legally delegated to certain sections of the world. Studies show that kids who fall off their bikes and hit their head without a helmet don’t do as well. It is now law for children to wear bike helmets.

We live in a world where no longer do we let our kids drink from certain “sippy cups” lest they be exposed to “something in the water”. My generation came of age at the dawn of prevention and has, in some areas, taken it to a whole other level.

But I wonder if we have gone too far. In an age to prevent exposures to ANY toxins have we fallen off the other side?

I am talking about vaccinations; Measles in particular.

In January 2014, the medical community celebrated the eradication of Polio worldwide. Smallpox has also been eradicated and daily we hear of new advances as the scientific world marches towards an HIV vaccine.

And now, measles is back.

The Measles vaccine was first introduced in 1963. The MMR vaccine, which covers Measles, Mumps and Rubella was first introduced in 1971. Five years before the vaccines was introduced, 500,000 people suffered annually from the measles.

The measles is caused by the rubeola virus an RNA virus of the genus Morbillivirus, family Paramyxoviridae. It is transmitted by droplet infection. It typically manifests itself with a flu like illness followed by a rash. The entire illness lasts about two weeks. People with measles are contagious for 4 days before they develop the rash and for four days after the rash subsides in addition to the time the rash is present ( a total of 12-14 days). Complications from the measles include pneumonia in 5 per cent of patients. Encephalitis (infection in the brain) develops in 1/1000 patients and death rates are 1-3/1000 patients.

This may not seem like significant numbers. But let’s recall that measles is PREVENTABLE.

The vaccine confers immunity with a single dose in 95 per cent of people. Children should be vaccinated just after their first birthday. In 1985 the CDC recommended a second dose vaccine due to falling rates of immunity. A second dose of the vaccine is given by age four. Alternatively people who have not been given a second dose of the MMR vaccine who travel to Measles endemic areas are given a  second dose of the vaccine. Two doses of the MMR vaccine offer 99 per cent immunity. A small percentage of people fail to mount an immune response and are considered vaccine failure.

The good news about this is the concept of HERD IMMUNITY. Herd immunity is based on the principle that the majority of the population is immune to an infection. If you live among the immune, their immunity guarantees your safety. The virus can’t infect those around you and so you won’t get sick from them, even if you are not vaccinated. Herd immunity rates for the measles exist provided that 90-95 per cent of the population is immune.

In the United States, overall measles vaccination rates are 90 per cent. In Canada they are 95 per cent overall, but as low as 50 per cent in some areas. In the United Kingdom rates are 80 per cent. In 2012, 1900 measles cases were reported. Rates of immunization in the Chilliwack, BC are as low as 60 per cent. This is where Canada’s latest outbreak has taken hold.

In 2000, measles had almost been eradicated in Canada. In 1998,Andrew Wakefield, a British gastroenterologist published a flawed study in Lancet suggesting a link between the MMR vaccine and the development of autism. In 2010, the Lancet retracted the article. Wakefield had been developing his own vaccine to be used if the MMR vaccine was withdrawn. It was shown that his study was not only flawed and manufactured but that he had a financial interest in the failure of the current vaccine. The UK withdrew his medical license in 2011.

Reduced rates of vaccination are indeed a result of the aftermath of this study. Since 1998, an overwhelming amount of studies have failed to show a causal link between autism and vaccination.

The science has failed to penetrate parental belief in certain cases.

And so misinformed parents waged a “war on vaccines” not based on science but based on a single false study and an overwhelming emotional response in part fuelled by media and misinformation.

Here’s the problem with NOT vaccinating your child. Children tend to play with each other. They tend to be exposed to a lot more infections than do adults. If you send your unvaccinated kid to daycare you had better hope everyone else vaccinated their kids FOR you. In order to be unvaccinated and protected you must rely on herd immunity. If rates fall below 90 per cent you run the risk of infection.

Vaccinations are still a parental choice. In Kenya, for example you can’t be let into the country unless you have a stamp in your passport confirming you have been vaccinated against yellow fever.

In Canada- we don’t insist on vaccinations. Sure, certain schools and daycares won’t take unvaccinated children, but no-one in Canada is going to hold you down and vaccinate your kid without your consent.

And so herd immunity has fallen and failed. Children under the age of 1 can’t yet be vaccinated and are now exposed to a virus that was all but eradicated at the turn of this century. Measles has now reached outbreak proportions. A virus that was once preventable is now back on the rise.

This gives rise to a medical crisis and a moral argument. Is exposing your child to a preventable sickness indeed ethical? Is taking a risk on a scientifically proven safe vaccine ethical? I’m not a parent. On a personal level, I’ve never had to make that decision.

As a physician and a scientist I weigh the risks and benefits and when it comes to vaccinations, the science shows the benefit far outweighs the risk.

As for the new measles outbreaks in Canada and the US?

Some will say it is a “benign” virus, others will “take their chances”. As a physician who treats the diseases we fail to prevent I shake my head at comments like this. As human beings it is in our nature to protect ourselves and the ones we love. We rely on science to show us the way. From Salk’s polio vaccine to Listerine’s revolutionary developments in sterilization, we have come along way in prevention of infections.

I fear with this “war on vaccines” we have raged an even more dangerous war on ourselves.